WHO estimates of the global, regional, and national disease burden of nine foodborne chemicals, 2000–21
an updated data synthesis
Lea S. Jakobsen (Technical University of Denmark (DTU))
Antonio Agudo (L’Hospitalet de Llobregat)
Louise Vaes (Universiteit Gent)
Mohammed Al Huthiel (Saudi Food and Drug Authority)
Fadi Al Natour (Abu Dhabi Agriculture and Food Safety Authority)
Carlotta di Bari (Universiteit Gent)
Brecht Devleesschauwer (Universiteit Gent)
Gabriela F. Nane (TU Delft - Electrical Engineering, Mathematics and Computer Science)
Sara M. Pires (Technical University of Denmark (DTU))
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Abstract
Background: We updated WHO estimates of the global, regional, and national foodborne disease burden caused by chemical hazards. We estimated incidence, mortality, and disability-adjusted life-years (DALYs) of aflatoxins B1 and M1, inorganic arsenic, lead, methylmercury, cadmium, dioxin, peanut allergy, and cassava cyanide for 2000–21. Methods: We used data from systematic reviews, established dose-response relationships, the Global Burden of Disease Study 2021, and, where applicable, a structured expert judgment study. We used disease-specific models and a hierarchical meta-regression model with geographical clustering and global linear time trend with uncertainty propagation. Findings: In 2021, the nine foodborne chemicals caused 6·26 million (95% uncertainty interval [UI] 3·36–10·30) cases, 1·12 million (0·40–2·10) deaths, and 29·8 million (12·9–53·1) DALYs globally. Inorganic arsenic and lead caused the highest burden. Cardiovascular diseases due to inorganic arsenic and lead caused 88·9% of foodborne chemical deaths and 76·5% of foodborne chemical DALYs. The greatest DALY rate was estimated for the South-East Asia region, with 789 DALYs (272–1660) per 100 000 people mostly due to inorganic arsenic and lead (94·2%). The region of the Americas carried the highest foodborne chemical DALY rate in children younger than 5 years, with 749 DALYs (435–1260) per 100 000 children, mainly due to the effect of methylmercury on intellectual disability (91·0%). DALY rates from dioxin showed the steepest decrease from 2000 to 2021. Interpretation: Dietary exposure to chemicals causes a substantial global disease burden. An integrated response with ongoing non-communicable disease prevention efforts is key. Granular assessment including subnational exposure contexts is essential to ensure equity. Funding: WHO.
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